From the Guidelines
A comprehensive neuropathy workup blood test panel should include HbA1c, vitamin B12, TSH, vitamin B6, folate, serum protein electrophoresis, and immunofixation, as well as additional testing guided by neuropathy phenotype, such as ANA, ESR, CRP, ANCA, and anti–smooth muscle antibodies 1. When evaluating a patient with neuropathy, it is essential to consider a broad range of potential causes, including reversible neuropathy causes, autoimmune conditions, and infectious diseases.
- Key components of the initial workup include:
- Serum testing for reversible neuropathy causes: HbA1c, vitamin B12, TSH, vitamin B6, folate, serum protein electrophoresis, and immunofixation
- Additional testing guided by neuropathy phenotype, such as ANA, ESR, CRP, ANCA, anti–smooth muscle, SSA/SSB, RNP, anti-dsDNA, ganglioside ab, anti-MAG, anti-Hu (ANNA-1 ab), thiamine, Lyme, hepatitis B or C, and HIV 1
- The specific tests ordered may vary depending on the patient's symptoms, medical history, and clinical presentation, and the physician may customize the workup accordingly.
- It is also important to consider consulting a neurologist to guide neuropathy phenotype determination and workup, as well as to consider additional testing such as MRI spine, MRI brain, or lumbar puncture, depending on the clinical presentation 1.
From the Research
Neuropathy Workup Blood Work
The workup for neuropathy typically involves a combination of clinical assessment, laboratory testing, and electrodiagnostic studies.
- Initial blood tests should include:
- These tests can help identify underlying causes of neuropathy, such as diabetes mellitus, hypothyroidism, and nutritional deficiencies.
Specialized Tests
- Specialized tests, such as serum protein electrophoresis with immunofixation, may be ordered if clinically indicated 3.
- Laboratory tests should be selected specifically according to the suspected type of neuropathy to avoid unnecessary tests and expenses 4.